Monday Make-over with Music

Monday arrives with regularity each week and, for many people, that means a sense of semi-dread, less-than-eager anticipation and the end of their weekend. But since Monday is always going to be coming next week, what about making it a little less unpleasant and helping yourself?

Researchers have, for years, looked at ways people have tried to help themselves to lift their mood or improve it to get ready for a variety of things such as getting themselves motivated, remaining on an exercise routine, or providing themselves with a pleasant stimulant that was not addictive, not prescription and always there. They've come up with a variety of things, but one which is proving to be helpful in so many ways is, simply, listening to music.

Remember that phrase about music having the charm to quiet the savage beast or breast as some quotations indicate?   One thing  which we were never thinking was happening was that music may be a form of exercise for the brain. We know that exercise, which works on the muscles, produces elevated mood and even memory enhancement. Now we know that exercising the brain with music can do us a world of good.

Some of the information that is coming out of brain research, indicates that music actually helps you in new ways to think and some scientists believe it transfers that ability to areas other than your thinking. Perhaps that's why for centuries people have taken their children to weekly music lessons because, without knowing it, they were helping these kids in their school work and their future careers. When scientists consider millenia of brain development, they found that the music-response area is actually older than the area of the brain that responds to language.

It's also thought to be involved in our brain's natural reward system and that's where the Monday benefit comes in. Since music is a stimulant which is enjoyable, the brain responds to it by releasing dopamine and this has been validated through brain imaging studies. And, it's the music alone even without words, that accounts for this pleasure. So it's a response to the rhythm and not the words, the  phrasing or the person singing the song.  In fact, the brain almost seems to anticipate the pleasure that the music will give by releasing dopamine prior to the optimal pleasure point in the music.

How does the brain do this? One researcher hypothesized that it was the brain anticipating pleasure as it explored the sensation of the music it heard. It almost sounds a little scary, as though the brain is functioning independently of us somehow and making decisions about how we're going to feel. But, as long as it keeps giving us those good vibrations, why not use them?

So, music is a pleasure mechanism and it's always available to us, no matter where we may happen to be and we can always make the decision to utilize it without getting anyone else's permission. That is, of course, unless you don't use headphones or earbuds and you prefer speakers which everyone will hear. That scenario could prove to be  not so pleasurable if those in close proximity to you didn't like your choice of music. You are forewarned.

Researchers at the University of Missouri found that music not only was pleasurable, but it contributed to personal happiness, better physical health, higher income  (I don't know how they figured that one out), and even greater relationship satisfaction.

The moral of the story, therefore, is to prepare for "Monday, Monday" by choosing the appropriate mood music that will propel you to moving and chase away a bit of the Monday blues.

Fired Up: A shrink's musings

Money, Breast Cancer, Genes & Angelina

The carefully guarded medical history and subsequent surgical intervention to prevent an 87% chance of developing breast cancer by actress Angelina Jolie has now hit the world's news after her Op-Ed  piece in the New York Times. Julie, whose mother died at just 56 from ovarian cancer, has the BRCA1  gene which also carries a  50% incidence of ovarian cancer.  

Unbelievably,  a controversy is currently filling the airwaves and the Internet with comments from people who take exception with Jolie's  decision. Personally, I think it's none of their business and I certainly don't think she did it in a cavalier manner, but was extremely thoughtful before she proceeded with any type of intervention. She has children and a companion who loves her and I'm sure it was for them and not only for herself that she made this painful choice. Everyone has to make their own health decisions about what is right for them and I take issue with their audacity in saying she shouldn't have done it. Hush up.

The other important issue, which I believe is being lost in these discussions, is the whole matter of the gene, how it is tested for, what is the cost and who will or will not be able to get it. There are women out there who have a strong family history of women in their family dying of breast cancer and they will not be able to use this option, even if they wanted to. The reason? It's what it always is; money.

The cost of the testing for this particular gene is usually around $3,000, but I've heard that the company may be raising it to $4,000. I don't believe they have any additional research costs or promotional costs or anything else to justify such an increase. Sounds like the cancer treatment that costs what? About $100K per year?

But I do believe that the publicity that has been given to the testing and the procedures possibly will increase their business significantly. When people may be willing to sell whatever little something they have to be able to afford a medical test to see if they will live or die from breast cancer, it's apparent that they are desperate. Desperate times do not justify avarice. Although I see the stock market indicator today was in the "high greed" range.

The entire issue of the human genome is something where greed has inveigled its way into the medical field and it is deeply entrenched. Strong words? I think they're called for. Even knowing that a woman has this lethal gene in her body may not be enough because she may not be able to afford or have the healthcare coverage to pay for any type of intervention. Healthcare has not yet come to everyone even though we believe that everyone is entitled to live whether they have a deadly gene in their body or not. We are supposed to be a country of compassion and medical advances that bring hope and  health to the poorest of women, men or children.

How much of an outcry would there be if we knew that there was an unaffordable test that could tell us which children would develop a certain type of cancer for which there might be a cure?  Would we deny the test to the children and would we permit it to be kept so expensive that only a privileged few could afford it?   I find myself at a loss to try to conceive of any reason why a life-saving test would have to be so expensive. It's not as though they're trying to pay off their research costs. Are they? Would the president of the company that has the patent for this test please answer that question. Ah, yes, it may be time for PR damage control now.

I've seen reports that indicate the entire human genome has not only been diagrammed, but much of the genes and even gene sequences have been patented. Researchers, when they are so inclined, speak out about how this prevents them from doing certain types of research because the patents prevent it. Here we have a case where someone has a patent that can alleviate the fear of breast cancer and possibly ovarian cancer and the patent holder grips it ever more tightly. Do you really need that Ferrari that much, sir?

Too bad Bill Gates didn't put part of his foundation's money into a fund to help underprivileged women get the test for the BRCA1 gene and treatment after the test if it were positive.

Fired Up: A shrink's musings

Not Just Another Media Icon

The woman who paved the way for all of the media psychologists we see on TV and hear on radio today, Dr. Joyce Brothers, died in her home today after a long illness, according to her daughter. After a long and highly successful career as both a commentator on human behavior, a best-selling author and after winning the $64,000 Question TV program,  Dr. Brothers  had a right to be proud of all of her accomplishments.

Sometimes in life we find our paths crossing those of the famous and mine did cross with Joyce's (she usually demanded to be called "Dr. Brothers")  and never corrected anyone if they thought she was a psychiatrist instead of a psychologist. We had two brief intereactions. I, at one time in my life, worked as a newspaper syndicate editor and I sat next to the man who helped produce all of Joyce's newspaper columns. It was while  there that I would occasionally see her coming in to drop off materials. A small, diminutive woman she had a fondness for full-length black mink coats even in the warm spring. It was, after all, a sign of her success.

From time to time I would hear about her or her various endeavors through friends in the media or someone who worked in publishing. I have to give her credit on at least a few points. Joyce was not an ambulance chaser as another psychologist was and when she heard that a psychologist with a large newspaper following had died, she did not get on the phone and attempt to pull all of those accounts to her column. Another psychologist did try just that ploy and failed.

Another incredible similarity between the two of us was that the topic on which Joyce based her game show appearance and ultimate winning streak was boxing. You may think that this is a rather unusual topic for a psychologist and it certainly was and this is where Joyce showed her insight into what the media would quickly grab onto. I have no idea if Joyce ever followed boxing, but I knew that she certainly did well on every single question they manage to throw at her. Scuttlebutt was  that the producers did not find her exactly to be what they wanted and they made her questions tougher. She persevered and won in the end. As a child, boxing matches was a passion in our family and I watched many of them but I was never quizzed on my knowledge of any of the bouts. BTW,  Joe Lewis was my favorite.

As luck would have it, we would come to, in one manner, face each other on a TV show. It was that international brouhaha over Elian Gonzalez the little boy who had come with his mother from Cuba to his relatives in Florida. I was to take the side that said Elian should remain here and Joyce the opposing side. I still have the tape because it was an interesting match where I managed to get in the fact that both of us were psychologists. Okay, was that a cheap shot? No I don't think so. And, Court TV loved that kind of stuff especially if there was a disagreement (an absolute necessity) between the two experts. Ever notice how the experts are balanced out on the TV news? Nancy Grace was the moderator of sorts since both I and Joyce were in separate studios and never actually met each other in person before or after our TV dual.

But Joyce is gone now and I know there are many people who will miss her and the down-to-earth comments she made on their personal situations. I think the only time you could say Joyce was involved in a controversy was when she wrote a book that included, as I  recall, both sex and cooking; quite an accomplishment. Her parents I'm sure were quite proud of her and they had every reason to be.

Another thing I would have to say I admired  about Joyce was the fact that she didn't hold people up to ridicule on TV for ratings. The show that she had on TV was primarily a variety show, not therapy as entertainment, as others seem to wish to see it.

Like all of us, there was one thing Joyce did not do and which I was told, in confidence, that she wanted and that was to run for the Senate from New York state. I'm sure she realized that she might have to do things that would not be in keeping with her personal code.

So long, Joyce, it was nice to know you from a distance. Now you've earned your rest and you don't have to run around from studio to studio or to try to please advertisers pushing products for older adults.

Addicts the Lot of Us

Addictions and phobias appear to be among two of the most popular topics of conversation in both social situations and the media. How many phobias are there, anyway? If you listen to some of the experts who appear to readily come up with new ones at the drop of a dime, quarter, whatever, they are innumerable. Years ago, some poor psychologist said there were over one thousand.  I wonder how he ever came up with that number without any scientific evidence.

Take anything you please, give it a name that perhaps may have a Latin root and voilà you have a new phobia. Forget about the fact that there may be little or no evidence for the existence of this specific new disorder. Most people don't give that a second thought. They just accept it at face value.

You, too,  can come up with any phobia you wish and just make it your own. It reminds me of the time I was studying French in college and just on a lark,  I devised the French equivalent of, "Look for the woman in the Chevy." If I were to repeat that to anyone who didn't speak French, they would think it might be a charming French expression. You know it obviously wasn't and it was just my little joke. But it sounded great in French.

Addictions, on the other hand, appear to serve many purposes, not all of them specific to the addict. For example, states  run lotteries where people can make enormous amounts of money for small wagers. How many people are glued to the TV set, or the Internet or whatever to find out the winning numbers? They are pouring money week after week into buying those tickets and they become "addicted?"

There are people who are genuinely addicted to gambling because, psychologically, it has the strongest pull of anything you can do. It's based on something called a variable ratio schedule. Simply stated this means you never know how many times you have to play for you to receive a reward. Receiving a reward, even after playing for 50 or hundred times, still causes you to come back again. It becomes stronger and stronger. Of course, you don't have to play even 50 times to win because many of the games will pay you a small sum for just playing 10 times or so. But even two dollars will keep you coming back. It's the reward that is everything and you are willing to bet that you will get it.

Now turn around and look where your tax money is being spent by that very same state that is running those lotteries that were, supposedly, to be used for furthering education. What are the states doing? Of course, they have to run programs to help gambling addicts stop gambling at the same time they are running gambling games. Who's the loser? Anyone who gambles or buys a lottery ticket.

There's lots of money in both addiction promotion and treatment, too. The patients or customers, whichever you choose, are pulled at both ends.  Recently, I saw that Lindsay Lohan was pretty fed up with rehab, even though she has been mandated to three months of rehab. She wants to leave the place where she is right now and go to another. Is it best that she have her choice of rehab facilities? I kind of doubt that because she's been to a lot of rehabs and the results don't seem to have been what was expected by anyone.  Does she need rehab? Is she addicted to something? Is it a substance, or fame, or wanting to be in the media? We don't know, but the treatments don't seem to be working for her.

We can only hope that Lindsay doesn't develop a phobia for rehabs because that would be a very difficult disorder to treat indeed. Has no one come up with a phobia for rehabs? Sounds like someone could make a name for themselves there.

My point here is not to cast aspersions on anyone who has either a bona fide phobia or an addiction. The point I'm trying to make is that there are too many disingenuous people who are trying to make a bit of money on both. If they have to come up with something that seems to get the right kind of buzz in the media and they get attention, I suppose that, and a fat pay day, is what they were looking for. The goal is not to treat the terrible pain that anyone who has an addiction or a phobia feels every day. There's nothing funny or in any way amusing about having an addiction or a phobia. Taking advantage of them should be criminal.

People don't set out to have either of these disorders but when they seek help they should receive it in an ethical, professional manner. It isn't personal weakness or laziness or silliness or stupidity that brings on either an addiction or a phobia. They are brought on because people are searching for answers to their personal pain. A state that fosters addiction at the same time they are funding treatments for the same addiction is like a dog chasing its tail. It also seems to be to be quite immoral.

I wonder if we can call a moratorium on the burgeoning plethora of addictions that people seem to keep coming up with to foster their personal or professional careers? Do you think that might happen? Sadly, I'm not very sanguine about it.

Fired Up: A shrink's musings

The Cleveland Kidnappings: Just a ride home?

The recent discovery in a Cleveland home of three women who were held and abused for 10 years has fired up innumerable people, including professionals, who believe they know the answer to how this happened. One woman's response was that she was abducted after she accepted a ride from a stranger. The stranger turned out to be her abductor and probably her rapist. The ride would not end at her intended destination. Yes, all she needed was a ride and someone "kindly" offered one.

When I hear that people don't believe she just wanted a ride home, it brings to mind what happened to me once many years ago. There are probably several similarities here, but mine fortunately didn't end in abduction.

My car had broken down, late at night on a busy highway and as I sat there in the rain, someone stopped their car and asked what the problem was. I indicated my car had broken down and I needed a ride into a specific town nearby. The man who was driving the car indicated he happened to be going to that town and would gladly give me a ride. I was thankful because, at the time, I had neglected to take any money with me and I only had one dime in my pocket.

As we drove, I noticed that he was not staying on the highway but veering off to a secluded area with which I was not familiar. When I commented on this, he indicated he had to pick up a friend and it would only be a short stop off. The streets were dark, there was no one out, the lights in many of the homes were out also. Most people at that time had already gone to bed.

The car pulled up to yet another home with darkened windows and the man indicated that his friend must have left. We then drove on and he began to ask me what I did and I told him I was going to college at night. Almost immediately, there was the beginning of a stream of negative comments about "you college girls." Now I knew there was definitely a problem and I needed to get out the car.

I insisted that he stop, even though the area was dark with few streetlights and no traffic. He became quite angry and when I told him I would jump out of the car, he did stop and off his car race, leaving me there deserted on a dark road. Fortunately, a police car came down the street and I flagged it down.

I told the policeman what had happened and he told me that I could not get in the car with him since he was alone. The train station was just a short distance away, the policeman indicated, and I could walk in front of the car as he drove behind me to the railroad station.

When we got to the railroad station, there were already three police cars there, including a sergeant, and they told me that the train did not stop normally at this location but that they would flag it down. They did get the train to make this unscheduled stop.  The policemen gave me one dollar for the bus that I would have to take when I got off the train and I boarded the and sat in one of the cars.

The conductor came toward me and asked if I had been run out of town by the police. He said this in a deadly serious manner. This wasn’t a joke he was making. I explained my situation to him, he gave me a form to fill out and mail in later with my train fare and went on to do his other chores.

So, when I see, that people don't believe this kind of thing can happen just because you accepted a ride from a stranger, I know it can because I had a very close call that night. I was fortunate in that my anger took over for my fear and I was able to get out of the car. I was also doubly fortunate that a police car just happened to be coming down the street a few minutes afterward. What might've happened? I don't like to even think about it but one thing that I do now is I never leave home without money in my pockets. I could have been a victim, too.

We are seeing far too many people also who think they know why the women didn't try to escape from that home. Allow me to emphasize "they think they know" because they really don't know. Stop all the conjecture and that goes for all the experts out there, too. I'm sure that once the women were held captive for as few as two or three days and subjected to horrendous, brutal behavior, they were prisoners who felt helpless and hopeless. It’s always the way you break the spirit of your enemy.

The thing to remember now is that all of us must be good neighbors and Good Samaritans who will report any suspicious activity or will help anyone in trouble. Don't start castigating these women for not being able to escape. Prisons are constructed in people's minds and escape may be almost unthinkable. 

Elizabeth Smart stated that her abductors said they would harm her family and that was one reason she was afraid to run. Almost in every case, the victim feels there are no options and that they must comply, especially if severe brutality and rape is involved.

All of us in the field of mental health know the power of rape as a tool of manipulation. We've seen it used in wartime to subjugate the "enemy." The military is having their own problems with sexual assault and they usually have turned a blind eye to rape in war zones.

Areas of this country, where people are captive by the criminality that exists there, may be seen as parochial war zones of a sort. What happened to these women's “protectors” and what was the reason there was not more thorough follow-up on their disappearances and several purported calls to the police? Answers to these questions will not come easily because this is a very uncomfortable, highly political situation.

Oh, and BTW, know which city has the highest number of missing women? I’ve been told its Washington, D.C.

Fired Up: A shrink’s musings

A Little Arsenic with Your Chicken?

The Food and Drug Administration may not be fully disclosing what is in our food that we may not want or which is even undesirable for maintaining health. Although they are supposed to be our watchdog experts, their standards may not meet our's for safety. We haven't, after all, given up our right to say what we want or do not want in terms of food regulation.

The latest blockbuster redux is that feed provided to chickens, turkeys and hogs contains arsenic that enables farmers to produce animals that not only grow faster but have meat which has a "healthier" color.  What is healthy about meat from animal that have been fed arsenic? It's like saying that people who die from carbon monoxide poisoning (causes reddish skin) have a nice healthy glow, but they're dead. 

You may remember that several years ago, we were finally told what was in the feed used to fatten cattle; animal parts from diseased or even dead animals that can lead to severe neurological disorders and death. Remember all those "downer" steers that were too sick to walk and the vow that, in the future, animal scraps from near the spinal cord would not be in cattle feed?  How close is "not too close" to the site of this virulent killer virus in the spinal column? And you insure this how?

A bit of information on arsenic and what it can do and how it works in our bodies might be helpful here. A Google search quickly revealed that:

1.  In 2009, two advocacy groups (The Center for Food Safety  and the Institute for Agriculture and Trade Policy) and U.S. Representative Steve Israel (D-NY) urged that legislation be passed to ban the use of arsenic in animal feed.  Health professionals also urged that exposure to arsenic in any form be avoided.  A lawsuit has now been initiated to force the FDA to revise their regulations and procedures to stop the use of arsenic in these feed products.  The counter-argument used by proponents for the use of continuing arsenic is that the arsenic being used is "organic" and a scientist may have uttered "arsenic is arsenic whether it's organic or not."  The argument here is that it's natural and, therefore, somehow not potentially destructive. Just tell that to the Borgias who used it to good effect.

2. Arsenic has no taste, no color, no smell and it does not evaporate. You, therefore, do not know if arsenic is present in anything you inhale, drink or eat. Yes, arsenic is even in the dirt outside your home and the paint (green) to place designs on ceramic pottery.

3. Chronic exposure to arsenic can result in cancer and physical damage including poor circulation, high blood pressure, heart disease, liver toxicity, diabetes, and reproductive effects. Children because of their rate of growth and maturation, especially in their nervous system, may be at highest risk after exposure.  They may also suffer from intellectual deficits because of arsenic exposure.

4. What are the usual symptoms of arsenic poisoning? They include headaches, confusion, severe diarrhea, and drowsiness, possible Vitamin A deficiency which is related to heart disease and night blindness.  Arsenic also mimics thiamine deficiency.

5. Blood levels of arsenic can be measured but it is also stored in hair, urine and fingernails. The body does try to get rid of it, but some of it sticks around.

The question now remains whether or not the lawsuit will be successful and if it is, how soon the prohibition of arsenic in animal feed will be initiated. We should also remember that if the FDA prohibits arsenic in animal feed here, they have no control over its use in countries abroad that may sell meats to us in various forms.

Fired Up: A shrink’s musings 

Shrink's "Bible" Gets Black Eye From Experts

The book costs $199 and is essential for anyone who wants to receive payment for providing treatment for a psychiatric disorder because the book, known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is literally the psychiatric Bible. If the disorder isn't in there, you can't get paid. Sometimes, even if the disorder is in the book you still can't get paid because insurance companies that use the book don't recognize every category of disorders as being within their reimbursement schedule.

Interestingly enough, the book is published by the American Psychiatric Association's  press and they are the ones who tightly control what goes in it and what comes out. This process has led to a number of difficulties for the book and its authors because more and more professionals are seeing it as being out of step with advances in medicine and clinical sciences as they relate to psychiatric disorders.

Publication date is scheduled for sometime in May 2013 and already one of the premier blogs from the National Institute of Mental Health sees it as lacking in validity and, therefore, of questionable use in clinical practice.  The book, as this blogger, Dr. Thomas Insel  stated,  depends solely on symptoms and symptom clusters. This is something where psychiatry differs because there is no objective medical tests for any psychiatric diagnosis.   Dr. Insel also  pointed out that the new direction in medicine is toward something he termed "precision medicine." By that he means that it will include everything such as genetics, imaging and hard data into the classification of a medical disorder. Aren't psychiatric disorders medical in any sense of the word or are they more psychological than medical? Good question.

Does this mean that the mental health field will no longer use this book? Obviously not since insurance companies will continue to use it and its categories of disorders for determining payments. Want to get paid? Make sure you use a disorder that has reimbursement attached to it. No, there are no asterisks on the disorders to alert you as to the reimbursable ones, but everybody knows which ones they are.

Where do the problems lie and what can be done about them? Obviously, the first problem is that every diagnosis, or pretty much every diagnosis, is based on clinical consensus of psychiatrists sitting on the committee. Consensus is not necessarily a good thing because it often is not backed up by hard evidence. Writing a chapter for a book on psychological disorders a number of years ago, I quickly found out that there are many things which appear to be psychiatric disorders and which can be caused by anything from poor diet, lack of sleep, lack of exercise, lack of socialization, medication interactions and it goes on and on and on. Know any psychiatrists who do any type of medical exam? That is except the ones we've seen found guilty of sexual assault.

Of course, the psychiatrists on the committee would pooh-pooh this and see me as just another disgruntled mental health professional. They have certainly had their share to contend with over the past few years as they worked on this latest edition of this book.

And what about the poor psychiatrists who are all attending their annual meeting in May and who will have to become conversant with this new book? The book isn't their only problem, however. A recent survey of earnings in the medical field found that psychiatrists rank among the bottom third. In some parts of the country they can make up to $300,000 or more and in others maybe just $100,000 or a bit over  and they are reporting greater displeasure with both working in their field and their dropping incomes.  Thirty-five percent of them only work about 30 to 40 hours a week. The usual number of patients ranges from 25 to 49 visits per week. I suspect that the ones who have 49 appointments a week are dealing in more medication checks than anything else. But the greater percentage of them (statistics unavailable right at the moment) do not do psychotherapy.  Training is now limited to pharmacological interventions rather than the talking cure. One of the most startling statistics that applies to both psychiatrists and physicians in general in 2012 is that only 6 to 7% take pride in being a physician.

What might they begin to do? A number of them have decided that they will no longer see Medicare or Medicaid patients because this pays below what they wish to earn. Forget about the fact that these patients, just like anybody else who has good insurance, need good mental health care.

So the field of psychiatry and the tools which they currently use, as it is practiced today, leaves much to be desired because of its lack of objectivity. Freud, even though he is not the giant he once may have been, was, after all, a neurologist and believed that mental ills were caused by the nervous system.

The negativity and the increased chatter on the Internet about psychiatry and mental illness may also have a good side; it has started a very important conversation and patients can only benefit from it.

Fired Up: A shrink's musings